Nokea
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement?
- A. Clean the skin with providone-iodine solution.
- B. Ensure that the area for electrode placement is dry.
- C. Apply tincture of benzoin to the electrode sites and wait for it to become tacky.
- D. Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
Correct Answer: D
Rationale: An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. Disinfecting the skin is unnecessary and conduction gel is used.
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A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the main goal of treatment is what?
- A. Decrease SA node conduction
- B. Control ventricular heart rate
- C. Improve oxygenation
- D. Maintain anticoagulation
Correct Answer: B
Rationale: Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. This is a priority because it directly affects cardiac output. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice, followed by anticoagulation with heparin and then Coumadin.
A cardiac care nurse is aware of factors that result in positive chronotropy. These factors would affect a patients cardiac function in what way?
- A. Exacerbating an existing dysrhythmia
- B. Initiating a new dysrhythmia
- C. Resolving ventricular tachycardia
- D. Increasing the heart rate
Correct Answer: D
Rationale: Stimulation of the sympathetic system increases heart rate. This phenomenon is known as positive chronotropy. It does not influence dysrhythmias.
The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient?
- A. Maintain a resting heart rate below 70 bpm.
- B. Maintain adequate control of chest pain.
- C. Maintain adequate cardiac output.
- D. Maintain normal cardiac structure.
Correct Answer: C
Rationale: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient?
- A. Start lifting the arm above the shoulder right away to prevent chest wall adhesion.
- B. Avoid cooking with a microwave oven.
- C. Avoid exposure to high-voltage electrical generators.
- D. Avoid walking through store and library antitheft devices.
Correct Answer: C
Rationale: High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function.
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG?
- A. P wave
- B. T wave
- C. QRS complex
- D. U wave
Correct Answer: C
Rationale: The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.